Forms

Hospitals/Hospital Personnel

• Base Hospital Medical Control Agreement
• EMT-II/P Receiving Hospital Agreement
• Satellite Hospital Medical Control Agreement
• Prehospital Care Medical Director Agreement
• Prehospital Care Nurse Coordinator Agreement

• MICN
  • (Re)Authorization Application
  • MICN Field Observation Verification
  • MICN New Personnel Orientation Documentation
  • MICN Tape Audit

Providers

• BLS Narcan Provider Contract
• BLS Narcan Report Form
• BLS Epinephrine (EpiPen) Auto Injector Provider Agreement
• First Responder Provider Agency Memorandum of Understanding
• Helicopter Service Provider Agency Memorandum of Understanding
• Limited Advanced Life Support and/or Advanced Life Support Agreement

Responders

• EMT-I
  • (Re)Certification Application
  • DOJ Livescan Form & Privacy Notice (NOTE: You MUST use this form if applying to NCEMS. You MUST have 3 copies of the DOJ Form. One for yourself, one for the person completing your scan and one for North Coast EMS)
  • CA EMT Skills Check Off Form
  • Credit Card Authorization 

• EMT-P
  • Paramedic Accreditation
  • Paramedic Re-accreditation
  • Paramedic Re-accreditation with LAPSE of less than two years